Pharmacy generally began with the compounding of medicines which entailed the actual mixing and preparing of medications. Heretofore, pharmacy has been, to a great extent, a profession of dispensing, that is, the pouring, counting, labeling a prescription, and transferring the dispensed medication to the patient. However, a new emphasis is beginning to arise, which is counseling in addition to merely dispensing medications. This entails educating the patient regarding the proper use and corresponding information about the medication that is needed to ensure proper therapeutic results and safety.
The trend toward more counseling is taking place to reduce medication errors and, thereby, decrease liability and insurance costs associated with the increase of medication use as the proportion of elderly persons in the population grows. Counseling is considered a major issue, and many states are changing their laws to make counseling mandatory. With counseling a mandatory requirement, pharmacists have to take on the role of educators and counselors regarding medications. One study showed that one out of five prescriptions was prescribed and dispensed without any verbal instructions to the patient. Without verbal instruction, patients will be extremely reluctant to make difficult choices and decisions about complicated therapeutic modalities. There will always be points that are not understood and questions that will have to be answered by the pharmacist, regardless of the degree of automation.
The main reason for the low level of consultation provided by pharmacists is a lack of time. Present day pharmacists devote more than sixty percent of their time to counting and pouting and other mundane tasks to meet quotas. This sixty percent does not include the time spent in locating the drug or reshelving the drug which in itself is a time consuming task. With the great emphasis being placed on counseling, and the economic reality of the volume of prescriptions filled, the conscientious pharmacist is faced with the dilemma of trying to satisfy the customers' needs as well as the need to make a profit.
Several attempts have been made to automate the pharmacy environment. One of these is the development of tablet counters. There are several types of tablet counters in existence today. In one type of counter, the pharmacist simply pours the tablets to be counted into a counting machine. The tablets are counted as they pass through the machine. This counter is simple and has the advantage that the tablets are stored in their shipped containers. However, this type of counter, as well as many other types of counters have the problem of cross contamination. As one type of drug is counted, a residue is left that can be picked up by the next drug which may cause a drug interaction or an allergic reaction. This counter also has problems with counting speed, double tablet counts, and half tablet counts. While this counter does reduce the tedious task of counting tablets, there is very little time savings because of the need to verify counts.
The Johnson et al. U.S. Pat. No. 4,018,358 discloses another type of commercially available counter which stores the drugs in special storage units or bins. When a prescription is to be filled, the proper bin must be located, removed from the shelf, inserted into a counter, and the desired number of tablets must be entered on a keyboard on the counter. When the entered number of tablets has been counted, the bin is removed from the counter and reshelved. The storage bin plus counter arrangement eliminates many of the problems of other counters, but still requires considerable tedious effort by the pharmacist and is prone to errors in selecting the correct bin and in entering the prescribed tablet count. Such counters are manufactured by Pharmaceutical Innovators, Ltd. of West Union, Iowa.
Still another type of dispenser is disclosed in the Lerner U.S. Pat. No. 4,247,019 and comprises a combined storage and counting unit called a Baker Cell. This device is based on technology which has been in existence for about fifteen years. Each cell is a storage unit having a volume of about one cubic foot and its own counter. The pharmacist locates the cell with the desired drug and enters the number of tablets to be dispensed on a keyboard of the cell. The tablets are then dispensed from a chute on the cell. Some of the newer models have computer interfaces allowing the computer to control the number of tablets dispensed. The Baker Cell has many serious practical problems. The pharmacist has to select the proper sized vial to use and physically locate the proper cell. The cells are large, occupying considerable shelf space. The cells cannot be bought, only leased at a considerable price per cell. The cells are set by the manufacturer to dispense a particular medication. If the pharmacist wants to change the type of medication dispensed, the cell must be returned to the manufacturer for recalibration. Baker Cell units are available from Automated Packaging Systems, Inc. of Twinsburg, Ohio.
While the current tablet dispensing devices attempt to aid the pharmacist in the task of dispensing, the time savings they provide are extremely limited in actual practice and in some cases are obtained at considerable cost. Each of the current dispensing devices only solves pain of the problem.
It can be concluded that there is a need for a fully automated device for retrieval and accurate counting of tablets and elimination of shelving requirements for stocks of tablets. Such a device should provide the flexibility to change the tablets being dispensed in a convenient way and should be able to dispense tablets without cross contamination of one medication with the next. Such a device should preferably be able to interface to a pharmacy's existing computer system.